Progress in surgical management strategies after neoadjuvant therapy in breast cancer

Objective: To summarize recent advances in surgical management strategies for breast cancer following neoadjuvant therapy (NAT), focusing on the potential to de-escalate surgery and optimize timing and techniques.

Methods: This is a narrative review synthesizing current literature and clinical evidence on surgical approaches after NAT.

Results: Advances in NAT have increased pathological complete response (pCR) rates, creating opportunities to reassess surgical strategies. For exceptional responders, accurate non-surgical assessment of residual cancer could potentially allow for the omission of surgery. For other patients, optimal timing of surgery after NAT can improve outcomes. Surgical de-escalation is a key theme: breast-conserving surgery or oncoplastic techniques can avoid mastectomy for primary tumors, while sentinel lymph node biopsy and novel techniques like targeted axillary dissection can minimize the need for extensive axillary lymph node dissection.

Conclusion: The evolution of NAT necessitates a refined understanding of the necessity, timing, and extent of surgery. Future research should focus on improving patient selection criteria and refining surgical techniques to enhance patient outcomes by safely de-escalating surgical intervention.